Kou Wenjun, Carlson Dustin A, Patankar Neelesh A, Kahrilas Peter J, Pandolfino John E
Feinberg School of medicine, Northwestern University, 676 North Saint Clair Street, Chicago, IL 60611, USA.
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Therap Adv Gastroenterol. 2020 Oct 24;13:1756284820969050. doi: 10.1177/1756284820969050. eCollection 2020.
This study aimed to introduce a novel analysis paradigm, referred to as 4-dimensional (4D) manometry based on biophysical analysis; 4D manometry enables the visualization of luminal geometry of the esophagus and esophagogastric junction (EGJ) using high-resolution-impedance-manometry (HRIM) data.
HRIM studies from two asymptomatic controls and one type-I achalasia patient were analyzed. Concomitant fluoroscopy images from one control subject were used to validate the calculated temporal-spatial luminal radius and time-history of intraluminal bolus volume and movement. EGJ analysis computed diameter threshold for emptying, emptying time, flow rate, and distensibility index (DI), which were compared with bolus flow time (BFT) analysis.
For normal control, calculated volumes for 5 ml swallows were 4.1 ml-6.7 ml; for 30 ml swallows 21.3 ml-21.8 ml. With type-I achalasia, >4 ml of intraesophageal bolus residual was present both pre- and post-swallow. The four phases of bolus transit were clearly illustrated on the time-history of bolus movement, correlating well with the fluoroscopic images. In the control subjects, the EGJ diameter threshold for emptying was 8 mm for 5 ml swallows and 10 mm for 30 ml swallows; emptying time was 1.2-2.2 s for 5 ml swallows (BFT was 0.3-3 s) and 3.25-3.75 s for 30 ml swallows; DI was 2.4-3.4 mm/mmHg for 5 ml swallows and 4.2-4.6 mm/mmHg for 30 ml swallows.
The 4D manometry system facilitates a comprehensive characterization of dynamic esophageal bolus transit with concurrent luminal morphology and pressure from conventional HRIM measurements. Calculations of flow rate and wall distensibility provide novel measures of EGJ functionality.
本研究旨在引入一种基于生物物理分析的新型分析范式，即四维（4D）测压法；4D测压法能够利用高分辨率阻抗测压（HRIM）数据可视化食管和食管胃交界处（EGJ）的管腔几何形状。
分析了来自两名无症状对照者和一名I型贲门失弛缓症患者的HRIM研究。使用一名对照受试者的同步荧光透视图像来验证计算出的时空管腔半径以及管腔内团块体积和运动的时间历程。EGJ分析计算排空直径阈值、排空时间、流速和扩张性指数（DI），并将其与团块流动时间（BFT）分析进行比较。
对于正常对照者，5毫升吞咽量的计算体积为4.1毫升至6.7毫升；30毫升吞咽量的计算体积为21.3毫升至21.8毫升。对于I型贲门失弛缓症患者，吞咽前后食管内团块残留均>4毫升。团块运动的时间历程清晰地显示了团块通过的四个阶段，与荧光透视图像相关性良好。在对照受试者中，5毫升吞咽量的EGJ排空直径阈值为8毫米，30毫升吞咽量的为10毫米；5毫升吞咽量的排空时间为1.2至2.2秒（BFT为0.3至3秒），30毫升吞咽量的为3.25至3.75秒；5毫升吞咽量的DI为2.4至3.4毫米/毫米汞柱，30毫升吞咽量的为4.2至4.6毫米/毫米汞柱。
4D测压系统有助于通过传统HRIM测量同时获得管腔形态和压力，全面表征食管团块的动态通过情况。流速和管壁扩张性的计算提供了EGJ功能的新指标。
